AB0291 QUICK ATTAINMENT OF LOW DISEASE ACTIVITY LESSENS THE DISEASE BURDEN OF RHEUMATOID ARTHRITIS IN THE LONG TERM, EVEN WHEN A TREAT-TO-TARGET APPROACH IS APPLIED
Authors: S. Snoeck Henkemans, M. Vis, A. Van der Helm – van Mil, P. De Jong
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Treat-to-target (T2T) strategies in early rheumatoid arthritis (RA) are aimed at achieving sustained remission or low disease activity. Remission and low disease activity are both associated with improved clinical outcomes and patient-reported outcomes (PROs). However, it is currently unknown if achieving sustained remission in the first year improves long-term PROs in RA. <h3>Objectives</h3> To examine associations between functional ability, health-related quality of life, pain and depression over 1-3 years in RA patients who have (1) sustained remission, (2) low disease activity or (3) active disease in the first year after the diagnosis is made. <h3>Methods</h3> We included all RA patients, according to 2010 or 1987 criteria, from the tREACH trial. The tREACH is a multicenter, stratified single blinded trial with a T2T approach, aiming for low disease activity (DAS44 &lt;2.4). Included patients were categorized in 3 groups depending on their DAS44/ESR-3 items (DAS), thus not including general health, in the first year: <b>Sustained remission</b>, includes patients who were in remission (DAS &lt;1.6) at the 6, 9 and 12 month visit; <b>Low disease activity</b>, includes patients who had low disease activity (DAS ≤2.4) at 6, 9 and 12 months and did not fit in the sustained remission group; <b>Active disease</b>, includes patients who had an active disease (DAS &gt;2.4) at least at 6 and 9 months, 6 and 12 months or 9 and 12 months. Functional ability was measured with the Health-Assessment Questionnaire – Disability Index (HAQ-DI). Health-related quality of life (HRQoL) was measured with the Short form-36 (SF-36). Pain was measured with a 10-point Likert scale and depression was measured with the Hospital Anxiety and Depression Scale (HADS). Linear mixed models from 1-3 years, with gender, initial treatment, DAS and baseline PRO score as covariates, were used to compare PROs over time. <h3>Results</h3> We included 304 RA patients (61% female) of whom 90 (30%) had sustained remission, 148 (49%) low disease activity and 66 (22%) active disease. RA patients with active disease were, compared to the low disease activity and remission groups, more often female (79% vs 65% vs 42%) and had more tender joints (median 14 (IQR 9-21) vs 8 (IQR 5-14) vs 5 (IQR 2-10)) and a higher baseline DAS (mean 3.6 (sd 0.8) vs 3.1 (sd 0.8) vs 2.8 (sd 0.9)). After 15 months all 3 groups had a mean DAS &lt;2.4 (Figure 1A). Nevertheless, RA patients in the active disease group continued to have more functional limitations and pain during 1-3 years of follow-up compared to the other groups, respectively low disease activity (β -0.35 (95% CI -0.47, -0.23), p&lt;0.001 for HAQ-DI and β -0.91 (95% CI -1.42, -0.39), p=0.001) for pain) and remission (β -0.42 (95%CI -0.57, -0.28), p&lt;0.001 for HAQ-DI and β -1.26 (95% CI -1.86, -0.66), p&lt;0.001) for pain) (Figure 1B-C). No differences were seen in depression scores and mental health items over time. However, at baseline, a higher proportion of RA patients in the active disease group (26%) had a score suggestive of the presence of depression (HADS &gt;7) compared to the low disease activity (18%) and sustained remission (13%) groups (Figure 1D). HRQoL was comparable to the general Dutch population after 1 and 3 years of follow-up, except for patients with an active disease (Figure 1E-F). <h3>Conclusion</h3> Failure to achieve remission or low disease activity in the first year after RA diagnosis is associated with persistent functional impairment and pain, despite the T2T approach that aims for low disease activity. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.